Healthcare Provider Details

I. General information

NPI: 1710481114
Provider Name (Legal Business Name): KALPANA KUGATHASAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 STONEBRIDGE PKWY BLDG 105
WATKINSVILLE GA
30677-6025
US

IV. Provider business mailing address

1199 PRINCE AVE # 70
ATHENS GA
30606-2797
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95551
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: